HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVE®
(772)462-1553 Fax(772)462-1578
OCT 212019
PERMIT RENEWAL REQUEST ST, l ucle County, Permitting
PERMIT NUMBER: SL c I%J0 -' ADDRESS: 2,I UJZV f P/ X/(Z el(Jj�D
I, Irl atA[I'A 2 fnoo 20S ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification We f--)e e-c� M060 V->J02(Z ab _ -
i
OWNE R OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA_
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 1A DAY OF d 20
BY tJd�C `� V Dh Z 05 WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED T`{s'�� c'� AS IDENTIFICATION.
STATE OF FLORIDA,County of �P* L�C'(-� :,n•• ` ': DEANNA MARIE GIVENS
g MY COMMISSION#GG 022023
EXPIRES:D
-�`�-+�
Bonded ecember 16,2020
SIGNATURE OF NO Y d Thm Notary Public Underwriters
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014